{"id":42885,"date":"2024-10-28T05:10:38","date_gmt":"2024-10-28T05:10:38","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=42885"},"modified":"2024-10-28T05:10:38","modified_gmt":"2024-10-28T05:10:38","slug":"%e6%8c%87%e5%8d%97%e6%a0%87%e5%87%86%e5%85%b1%e8%af%86%e2%94%82%e5%84%bf%e7%ab%a5%e7%89%b9%e5%8f%91%e6%80%a7%e7%9f%ae%e8%ba%ab%e6%9d%90%e8%af%8a%e6%96%ad%e4%b8%8e%e6%b2%bb%e7%96%97","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=42885","title":{"rendered":"\u6307\u5357·\u6807\u51c6·\u5171\u8bc6\u2502\u513f\u7ae5\u7279\u53d1\u6027\u77ee\u8eab\u6750\u8bca\u65ad\u4e0e\u6cbb\u7597\u4e2d\u56fd\u4e13\u5bb6\u5171\u8bc6"},"content":{"rendered":"
\n

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\u798f\u68e0\u513f\u7ae5\u533b\u5b66\u53d1\u5c55\u7814\u7a76\u4e2d\u5fc3<\/p>\n

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\u4e2d\u56fd\u5b9e\u7528\u513f\u79d1\u6742\u5fd7  2023 Vol.38\uff0811\uff09\uff1a801-813<\/p>\n

\u6458\u8981<\/p>\n

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\u5173\u952e\u8bcd<\/p>\n

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\u513f\u7ae5\u8eab\u6750\u77ee\u5c0f\u75c7\uff08short stature\uff0cSS\uff09\u662f\u4e00\u79cd\u53d7\u9057\u4f20\u3001\u8868\u89c2\u9057\u4f20\u548c\u73af\u5883\u7b49\u591a\u79cd\u56e0\u7d20\u8c03\u63a7\u7684\u75be\u75c5\uff3b1\uff3d\u300260%\uff5e80%\u8eab\u6750\u77ee\u5c0f\u513f\u7ae5\u7684\u75c5\u56e0\u65e0\u6cd5\u660e\u786e\uff0c\u88ab\u5f52\u4e3a\u7279\u53d1\u6027\u77ee\u8eab\u6750\uff08idiopathic short stature\uff0cISS\uff09\uff3b2-4\uff3d\u3002<\/p>\n

ISS\u7684\u5b9a\u4e49\u3001\u8bca\u65ad\u8bc4\u4f30\u65b9\u6cd5\u53ca\u6cbb\u7597\u4e00\u76f4\u662f\u88ab\u5173\u6ce8\u548c\u88ab\u8ba8\u8bba\u7684\u70ed\u70b9\u30022008\u5e74\u56fd\u9645\u751f\u957f\u6fc0\u7d20\u7814\u7a76\u5b66\u4f1a\u3001Lawson Wilkins\u513f\u79d1\u5185\u5206\u6ccc\u5b66\u4f1a\u53ca\u6b27\u6d32\u513f\u79d1\u5185\u5206\u6ccc\u5b66\u4f1a\u8054\u5408\u53d1\u5e03\u4e86ISS\u8bca\u65ad\u548c\u6cbb\u7597\u7684\u5171\u8bc6\u58f0\u660e\uff3b5\uff3d\u3002\u76ee\u524d\u6211\u56fd\u5c1a\u65e0ISS\u8bca\u7597\u5171\u8bc6\u6216\u6307\u5357\u30022013\u5e74\u4e2d\u534e\u533b\u5b66\u4f1a\u513f\u79d1\u5b66\u5206\u4f1a\u5185\u5206\u6ccc\u9057\u4f20\u4ee3\u8c22\u5b66\u7ec4\u300a\u57fa\u56e0\u91cd\u7ec4\u4eba\u751f\u957f\u6fc0\u7d20\u513f\u79d1\u4e34\u5e8a\u89c4\u8303\u5e94\u7528\u7684\u5efa\u8bae\u300b\uff3b6\uff3d\u4e2d\u63d0\u53ca\u4e86\u6211\u56fdISS\u4f7f\u7528\u91cd\u7ec4\u4eba\u751f\u957f\u6fc0\u7d20\u7684\u6cbb\u7597\u65b9\u6848\u3002\u8fd1\u5e74\u6765\uff0c\u968f\u7740\u9057\u4f20\u5b66\u68c0\u6d4b\u6280\u672f\u7684\u53d1\u5c55\u548c\u4e34\u5e8a\u533b\u751f\u5bf9\u8c03\u63a7\u751f\u957f\u53d1\u80b2\u76f8\u5173\u673a\u5236\u7684\u6df1\u5165\u7406\u89e3\uff0c25%\uff5e40%\u66fe\u88ab\u8bca\u65ad\u4e3aISS\u7684\u60a3\u513f\u83b7\u5f97\u4e86\u660e\u786e\u8bca\u65ad\uff3b7\uff3d\u3002\u968f\u7740\u7cbe\u51c6\u533b\u5b66\u53ca\u8bca\u6cbb\u4e2a\u4f53\u5316\u7684\u63a8\u8fdb\uff0c\u56fd\u5185\u5916\u5f88\u591a\u4e13\u5bb6\u63d0\u51fa\u4e86\u91cd\u65b0\u601d\u8003ISS\u8bca\u6cbb\u6d41\u7a0b\u7684\u5efa\u8bae\uff3b8\uff3d\u3002<\/p>\n

\u4e3a\u6b64\uff0c\u4e2d\u534e\u533b\u5b66\u4f1a\u513f\u79d1\u5b66\u5206\u4f1a\u5185\u5206\u6ccc\u9057\u4f20\u4ee3\u8c22\u5b66\u7ec4\u3001\u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u9752\u6625\u671f\u5065\u5eb7\u4e0e\u533b\u5b66\u4e13\u4e1a\u59d4\u5458\u4f1a\u3001\u798f\u68e0\u513f\u7ae5\u533b\u5b66\u53d1\u5c55\u7814\u7a76\u4e2d\u5fc3\u548c\u300a\u4e2d\u56fd\u5b9e\u7528\u513f\u79d1\u6742\u5fd7\u300b\u7f16\u8f91\u59d4\u5458\u4f1a\u7ec4\u7ec7\u4e13\u5bb6\uff0c\u6309\u7167\u4e34\u5e8a\u4e13\u5bb6\u5171\u8bc6\u7684\u5236\u8ba2\u65b9\u6cd5\u4e0e\u6b65\u9aa4\uff0c\u7ecf\u53cd\u590d\u8ba8\u8bba\u548c\u8bba\u8bc1\u800c\u64b0\u5199\u672c\u5171\u8bc6\u3002<\/p>\n

1\u3000\u5236\u8ba2\u65b9\u6cd5<\/p>\n

\u4ee5\u201cidiopathic short stature\u201d\u3001\u201cshort stature\u201d\u3001\u201c\u7279\u53d1\u6027\u77ee\u8eab\u6750\u201d\u548c\u201c\u8eab\u6750\u77ee\u5c0f\u75c7\u201d\u7b49\u68c0\u7d22\u8bcd\u4e8e2022\u5e7410\u6708\u5728PubMed\u3001\u4e07\u65b9\u6570\u636e\u5e93\u548c\u4e2d\u56fd\u77e5\u7f51\u7b49\u6570\u636e\u5e93\u8fdb\u884c\u4e86\u5168\u9762\u7684\u6587\u732e\u68c0\u7d22\uff0c\u5e76\u4e8e2023\u5e744\u6708\u8fdb\u884c\u4e86\u68c0\u7d22\u66f4\u65b0\u3002\u672c\u5de5\u4f5c\u7ec4\u75319\u540d\u6838\u5fc3\u6210\u5458\u6267\u7b14\uff0c40\u540d\u4e13\u5bb6\u5bf9\u5171\u8bc6\u7684\u5173\u952e\u6027\u95ee\u9898\u901a\u8fc7\u95ee\u5377\u8fdb\u884c\u6295\u7968\uff0c\u6839\u636e\u6536\u5230\u7684\u6295\u7968\u6bd4\u4f8b\u8fbe\u6210\u5171\u8bc6\uff1a26%\uff5e<50%\u4e3a \uff1b50%\uff5e<75%\u4e3a \uff1b\u226575%\u4e3a \u3002\u6700\u540e\u9080\u8bf765\u540d\u513f\u79d1\u5185\u5206\u6ccc\u4e13\u5bb6\u5171\u540c\u8ba8\u8bba\u5ba1\u6838\u3002<\/p>\n

2\u3000ISS\u7684\u5b9a\u4e492.1\u3000ISS\u8bca\u65ad\u540d\u79f0\u7684\u7531\u6765\u3000\u201cISS\u201d\u4e00\u8bcd\u4e8e20\u4e16\u7eaa70\u5e74\u4ee3\u9996\u6b21\u88ab\u63d0\u51fa\uff3b9\uff3d\uff0c\u7528\u4e8e\u63cf\u8ff0\u8eab\u6750\u77ee\u5c0f\u3001\u975e\u751f\u957f\u6fc0\u7d20\u7f3a\u4e4f\u75c7\u7684\u513f\u7ae5\uff3b10\uff3d\u30021979\u5e74\u4eba\u751f\u957f\u6fc0\u7d20\uff08human growth hormone\uff0chGH\uff09\u5de5\u4e1a\u5316\u91cf\u4ea7\u540e\uff0cISS\u4eba\u7fa4\u88ab\u7eb3\u5165hGH\u6cbb\u7597\u7684\u7814\u7a76\u8303\u56f4\uff3b11-12\uff3d\u30021983\u5e7412\u6708\u7f8e\u56fd\u56fd\u7acb\u536b\u751f\u7814\u7a76\u9662\u8ba4\u53ef\u4e86\u201cISS\u201d\u7684\u8bca\u65ad\uff3b13\uff3d\u3002\u81ea\u6b64ISS\u88ab\u7528\u4f5c\u56fd\u9645\u513f\u79d1\u5185\u5206\u6ccc\u75be\u75c5\u5206\u7c7b\u4e2d\u7684\u8bca\u65ad\u7c7b\u522b\u3002<\/p>\n

\u201c\u7279\u53d1\u6027\u201d\u6307\u75c5\u56e0\u4e0d\u660e\uff0c\u662f\u4e00\u79cd\u6682\u65f6\u6027\u72b6\u6001\uff3b14\uff3d\u3002\u7279\u53d1\u6027\u77ee\u8eab\u6750\u63cf\u8ff0\u7684\u662f\u6682\u65f6\u672a\u660e\u539f\u56e0\u7684\u8eab\u6750\u77ee\u5c0f\u7684\u72b6\u6001\u3002\u968f\u7740\u68c0\u6d4b\u6280\u672f\u4e0d\u65ad\u53d1\u5c55\u8fdb\u6b65\u5e76\u4e14\u5728\u4e34\u5e8a\u4e0a\u5e7f\u6cdb\u5e94\u7528\uff0c\u8d8a\u6765\u8d8a\u591a\u7684\u66fe\u7ecf\u88ab\u8bca\u65ad\u4e3aISS\u7684\u75be\u75c5\u75c5\u56e0\u5f97\u4ee5\u660e\u786e\uff0c\u88ab\u9010\u6b65\u79fb\u51faISS\uff0c\u6545\u201cISS\u201d\u60a3\u513f\u7684\u6bd4\u4f8b\u5c06\u8d8a\u6765\u8d8a\u5c11\u3002<\/p>\n

2.2\u3000ISS\u7684\u5b9a\u4e49\u3000ISS\u662f\u4e00\u7ec4\u5c1a\u672a\u660e\u786e\u75c5\u56e0\uff0c\u9ad8\u5ea6\u5f02\u8d28\u7684\u77ee\u5c0f\u75be\u75c5\u7684\u7edf\u79f0\uff0c\u6307\u8eab\u9ad8\u4f4e\u4e8e\u540c\u5e74\u9f84\u3001\u6027\u522b\u548c\u79cd\u65cf\u7684\u5e73\u5747\u8eab\u9ad82\u4e2a\u6807\u51c6\u5dee\uff08standard deviation\uff0cSD\uff09\u6216\u4f4e\u4e8e\u7b2c3\u767e\u5206\u4f4d\u6570\uff08P3\uff0c-1.88 SD\uff09\u8005\uff0c\u4e14\u51fa\u751f\u8eab\u957f\u3001\u4f53\u91cd\u53ca\u8eab\u6750\u6bd4\u4f8b\u5747\u6b63\u5e38\uff0c\u672a\u53d1\u73b0\u5168\u8eab\u6027\u3001\u5185\u5206\u6ccc\u3001\u8425\u517b\u3001\u67d3\u8272\u4f53\u5f02\u5e38\u6216\u57fa\u56e0\u53d8\u5f02\u8bc1\u636e\u7684\u77ee\u5c0f\u513f\u7ae5\uff08\u7ed3\u679c\uff1a 81.08%\uff09\u3002ISS\u5305\u62ec\u75c5\u56e0\u5c1a\u672a\u660e\u786e\u7684\u5bb6\u65cf\u6027\u8eab\u6750\u77ee\u5c0f\uff08familial short stature\uff0cFSS\uff09\u548c\u4f53\u8d28\u6027\u751f\u957f\u53d1\u80b2\u5ef6\u8fdf\uff08constitutional delay of growth and puberty\uff0cCDGP\uff09\u3002<\/p>\n

ISS\u8bca\u65ad\u7a0b\u5e8f\u662f\u6392\u9664\u6027\u8fdb\u884c\uff0c\u8981\u6392\u9664\u539f\u53d1\u6027\u751f\u957f\u969c\u788d\uff08\u5982\u9057\u4f20\u6027\u7efc\u5408\u5f81\uff09\u548c\u7ee7\u53d1\u6027\u751f\u957f\u969c\u788d\uff0c\u5305\u62ec\u4e0e\u73af\u5883\u3001\u6fc0\u7d20\uff0c\u8425\u517b\u548c\uff08\u6216\uff09\u5168\u8eab\u5668\u8d28\u6027\u75be\u75c5\u6709\u5173\u7684\u591a\u79cd\u75be\u75c5\uff3b2\uff3d\u3002<\/p>\n

3\u3000ISS\u7684\u8bca\u65ad<\/p>\n

\u5bf9\u8eab\u6750\u77ee\u5c0f\u60a3\u513f\u7684\u8be6\u7ec6\u8bc4\u4f30\u5e94\u5305\u62ec\u51c6\u786e\u7684\u75c5\u53f2\u3001\u6807\u51c6\u5316\u7684\u4f53\u683c\u68c0\u67e5\u3001\u5e38\u89c4\u548c\u7279\u5b9a\u7684\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u3001\u5f71\u50cf\u5b66\u68c0\u67e5\u548c\u9057\u4f20\u5b66\u68c0\u6d4b\u3002\u513f\u7ae5\u8eab\u6750\u77ee\u5c0f\u75c7\u7684\u75c5\u56e0\u590d\u6742\uff0c\u660e\u786e\u75c5\u56e0\u53ca\u53d1\u75c5\u673a\u5236\u59cb\u7ec8\u662f\u6311\u6218\uff0c\u4e13\u5bb6\u6295\u7968\u610f\u89c1\u89c1\u88681\u3002<\/p>\n

\u5177\u6709\u4ee5\u4e0b\u4efb\u4f55\u7279\u5f81\u7684\u77ee\u5c0f\u513f\u7ae5\u987b\u8fdb\u884c\u75c5\u7406\u539f\u56e0\u7684\u8bc4\u4f30\uff1a\u8eab\u9ad8\u6807\u51c6\u5dee\u79ef\u5206\uff08height standard deviation score\uff0cHt SDS\uff09< -2.0\u6216-1.88\uff0c\u6216\u660e\u663e\u504f\u79bb\u5bb6\u65cf\u8eab\u9ad8\u80cc\u666f\uff0c\u6216Ht SDS\u663e\u8457\u4e0b\u964d\uff08> 1.0 SD \/\u5e74\uff09\u6216\u751f\u957f\u901f\u5ea6\u5728<2\u5c81\u513f\u7ae5\u4e2d<7.0 cm\/\u5e74\uff0c2\uff5e<4\u5c81\u513f\u7ae5<5.5 cm\/\u5e74\uff0c4\uff5e<6 \u5c81\u513f\u7ae5<5.0 cm\/\u5e74\uff0c6\u5c81\u81f3\u9752\u6625\u671f\u524d\u513f\u7ae5<4.0 cm\/\u5e74\uff0c\u9752\u6625\u671f\u513f\u7ae5<6.0 cm\/\u5e74\uff3b15\uff3d\u3002\u51c6\u786e\u6d4b\u91cf\u5e76\u5b9a\u671f\u76d1\u6d4b\u513f\u7ae5\u8eab\u9ad8\u975e\u5e38\u91cd\u8981\uff0c3\u5c81\u4ee5\u4e0b\u513f\u7ae5\u5e94\u4ef0\u5367\u4f4d\u6d4b\u91cf\u8eab\u957f\uff0c3\u5c81\u4ee5\u4e0a\u513f\u7ae5\u7acb\u4f4d\u6d4b\u91cf\u8eab\u9ad8\u3002\u4e24\u6b21\u6d4b\u91cf\u81f3\u5c11\u95f4\u96943\uff5e6\u4e2a\u6708\uff0c\u6700\u597d\u95f4\u96946\uff5e12\u4e2a\u6708\u624d\u80fd\u51c6\u786e\u5730\u786e\u5b9a\u751f\u957f\u901f\u5ea6\u3002\u4f7f\u7528\u540c\u79cd\u65cf\u4eba\u7fa4\u7684\u6807\u51c6\u5316\u751f\u957f\u66f2\u7ebf\u8bc4\u4f30\u4e5f\u5341\u5206\u91cd\u8981\uff0c\u672c\u5171\u8bc6\u5efa\u8bae\u4f7f\u7528\u300a\u4e2d\u56fd0\uff5e18\u5c81\u513f\u7ae5\u3001\u9752\u5c11\u5e74\u8eab\u9ad8\u3001\u4f53\u91cd\u7684\u6807\u51c6\u5316\u751f\u957f\u66f2\u7ebf\u8868\u300b\uff3b16\uff3d\u3002\u7ed8\u5236\u8eab\u9ad8\u66f2\u7ebf\u4ee5\u53ca\u7236\u6bcd\u7684\u8eab\u9ad8\u6709\u52a9\u4e8e\u786e\u5b9a\u57fa\u4e8e\u5bb6\u65cf\u9057\u4f20\u80cc\u666f\u7684\u9884\u6d4b\u751f\u957f\u6a21\u5f0f\uff0c\u8bc4\u4f30\u60a3\u513f\u8eab\u9ad8\u72b6\u6001\u662f\u5426\u4f4d\u4e8e\u9057\u4f20\u9776\u8eab\u9ad8\uff08target height\uff0cTH\uff09\u8303\u56f4\u3002TH\u7684\u8ba1\u7b97\u5e38\u7528Tanner\u6cd5\uff1a\u5973\u7ae5TH\uff08cm\uff09=\uff3b\uff08\u7236\u8eab\u9ad8 \u6bcd\u8eab\u9ad8-13\uff09\/2\uff3dcm\u6216\u7537\u7ae5TH\uff08cm\uff09=\uff3b\uff08\u7236\u8eab\u9ad8 \u6bcd\u8eab\u9ad8 13\uff09\/2\uff3dcm\u3002\u5f53\u513f\u7ae5Ht SDS < TH SDS-1.6\u65f6\uff0c\u5373\u5973\u7ae5Ht SDS<\uff08TH-160.6\uff09\/5.4\u22121.6\uff1b\u7537\u7ae5Ht SDS<\uff08TH-172.7\uff09\/6.0-1.6\u65f6\u8003\u8651\u4e3a\u504f\u79bb\u5bb6\u65cf\u9057\u4f20\u80cc\u666f\u7684\u8eab\u6750\u77ee\u5c0f\u3002\u53e6\u5916\uff0c\u8fd8\u9700\u8981\u6839\u636e\u513f\u7ae5\u9752\u6625\u671f\u53d1\u80b2\u7684\u72b6\u6001\u8bc4\u4f30\u5176\u8eab\u9ad8\u72b6\u6001\u3002<\/p>\n

3.1    \u4e34\u5e8a\u8bc4\u4f30    \u4e34\u5e8a\u533b\u751f\u7684\u4e13\u4e1a\u7d20\u517b\u53ca\u9274\u522b\u8bca\u65ad\u80fd\u529b\u5bf9\u4e8e\u660e\u786e\u75c5\u56e0\u975e\u5e38\u91cd\u8981\u3002\u4e34\u5e8a\u8bc4\u4f30\uff08\u75c5\u53f2\u548c\u67e5\u4f53\uff09\u3001\u8f85\u52a9\u68c0\u67e5\uff08\u5e38\u89c4\u7684\u3001\u5185\u5206\u6ccc\u6fc0\u7d20\u548c\u5f71\u50cf\u5b66\u68c0\u67e5\uff09\u548c\u9057\u4f20\u5b66\u68c0\u6d4b\u8bc4\u4f30\u5177\u6709\u540c\u7b49\u91cd\u8981\u7684\u4f5c\u7528\u5e76\u5e94\u7efc\u5408\u8bc4\u4f30\u5224\u65ad\u3002\u75c5\u53f2\u91c7\u96c6\u5f15\u51fa\u60a3\u513f\u51c6\u786e\u7684\u751f\u957f\u6a21\u5f0f\u3001\u53d1\u80b2\u8f68\u8ff9\u548c\u5168\u8eab\u7cfb\u7edf\u6027\u75c7\u72b6\uff0c\u6536\u96c6\u6bcd\u5b55\u60c5\u51b5\u548c\u5bb6\u65cf\u8c31\u7cfb\u7b49\u975e\u5e38\u91cd\u8981\uff0c\u540c\u65f6\u8fd8\u5e94\u6ce8\u610f\u8bc4\u4f30\u60a3\u513f\u548c\u7236\u6bcd\u5bf9\u8eab\u9ad8\u7684\u770b\u6cd5\u4ee5\u53ca\u5173\u6ce8\u7a0b\u5ea6\u3002\u5177\u4f53\u4e34\u5e8a\u8bc4\u4f30\u6d41\u7a0b\u89c1\u56fe1\u3002<\/p>\n

3.2    \u8f85\u52a9\u68c0\u67e5    \u5bf9\u4e8e\u4e0d\u660e\u539f\u56e0\u7684\u8eab\u6750\u77ee\u5c0f\u513f\u7ae5\uff0c\u5e94\u8fdb\u884c\u5e38\u89c4\u7684\u8840\u6db2\u68c0\u67e5\uff0c\u89c1\u88682\uff3b8\uff0c17\uff3d\uff0c\u4ee5\u6392\u9664\u975e\u5185\u5206\u6ccc\u539f\u56e0\uff0c\u4f8b\u5982\u8d2b\u8840\u3001\u809d\u529f\u80fd\u5f02\u5e38\u3001\u6162\u6027\u80be\u529f\u80fd\u8870\u7aed\u3001\u8425\u517b\u4e0d\u826f\u3001\u538c\u98df\u75c7\u3001\u9178\u78b1\u5931\u8861\u3001\u7535\u89e3\u8d28\u7d0a\u4e71\u548c\u9aa8\u4ee3\u8c22\u5f02\u5e38\u7b49\u3002\u82e5\u60a3\u513f\u4f34\u6709\u6162\u6027\u8179\u6cfb\u3001\u8179\u80c0\u3001\u6c34\u80bf\u3001\u4f53\u91cd\u51cf\u8f7b\u7b49\u4e34\u5e8a\u8868\u73b0\uff0c\u8fd8\u5e94\u68c0\u6d4b\u6297\u7ec4\u7ec7\u8f6c\u8c37\u6c28\u9170\u80fa\u9176IgA\u548c\u603bIgA\uff0c\u4ee5\u6392\u9664\u4e73\u7cdc\u6cfb\u7684\u53ef\u80fd\uff3b8\uff3d\u3002<\/p>\n

\u5185\u5206\u6ccc\u7cfb\u7edf\u75be\u75c5\uff0c\u4f8b\u5982\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000\u6216\u751f\u957f\u6fc0\u7d20\u7f3a\u4e4f\u75c7\uff08growth hormone deficiency\uff0cGHD\uff09\u7b49\u5fc5\u987b\u9664\u5916\u540e\u624d\u80fd\u8bca\u65ad\u4e3aISS\u3002\u8bc4\u4f30GH-\u80f0\u5c9b\u7d20\u6837\u751f\u957f\u56e0\u5b50\uff08IGF\uff09s\u8f74\u7684\u60c5\u51b5\uff0c\u4e0eGHD\u9274\u522b\u662f\u8bca\u65adISS\u5fc5\u8981\u7684\u6b65\u9aa4\uff0c\u4f46\u5e76\u975e\u6240\u6709\u77ee\u5c0f\u60a3\u513f\u90fd\u9700\u8981\u8fdb\u884c\u751f\u957f\u6fc0\u7d20\u6fc0\u53d1\u8bd5\u9a8c\uff08growth hormone stimulation test\uff0cGST\uff09\u3002\u4e3a\u9664\u5916\u60a3\u513fGH-IGFs\u8f74\u5f02\u5e38\uff0c\u9996\u5148\u68c0\u6d4b\u60a3\u513f\u8840\u6e05IGF-1\u6c34\u5e73\uff0c\u89c1\u56fe1\u3002\u82e5IGF-1\u6c34\u5e73\u9ad8\u4e8e\u5747\u503c\uff0c\u5219GHD\u53ef\u80fd\u6027\u4f4e\uff0c\u53ef\u8fdb\u4e00\u6b65\u6392\u67e5\u662f\u5426\u7b26\u5408ISS\u7684\u8bca\u65ad\u3002\u82e5IGF-1\u6c34\u5e73\u964d\u4f4e\uff0c\u5e94\u884cGST\u548c\uff08\u6216\uff09\u5782\u4f53\u78c1\u5171\u632f\u6210\u50cf\uff08MRI\uff09\u3002\u82e5GST\u4e2dGH\u5cf0\u503c\u6b63\u5e38\u6216\u660e\u663e\u5347\u9ad8\uff0c\u9700\u884cIGF-1\u751f\u6210\u8bd5\u9a8c\uff0c\u4ee5\u9664\u5916GH\u4e0d\u654f\u611f\uff1b\u82e5GH\u5cf0\u503c<7 \u03bcg\/L\u548c\uff08\u6216\uff09MRI\u5f02\u5e38\uff0c\u7ed3\u5408\u76f8\u5e94\u4e34\u5e8a\u8868\u73b0\u8003\u8651\u4e3aGHD\u3002\u4f46\u5e94\u6ce8\u610f\uff0c\u80a5\u80d6\u4e00\u822cIGF-1\u504f\u9ad8\u800cGH\u5cf0\u503c\u51cf\u4f4e\u3002\u5efa\u8bae\u5c06IGF-1\u68c0\u6d4b\u7ed3\u679c\u4e0e\u5177\u6709\u53ef\u9760\u53c2\u8003\u6570\u636e\u7684\u3001\u4e0e\u5e74\u9f84\u6027\u522b\u5339\u914d\u7684\u513f\u79d1\u53c2\u8003\u8303\u56f4\u8fdb\u884c\u6bd4\u8f83\u3002\u4e0d\u540c\u56fd\u5bb6\u5bf9\u884cGST\u7684\u6761\u4ef6\u6709\u6240\u5dee\u5f02\uff1a\u5fb7\u56fd\u3001\u82f1\u56fd\u3001\u4e39\u9ea6\u7b49\u8981\u6c42IGF-1\u4f4e\u4e8e-2SD\u624d\u80fd\u8fdb\u884cGST\uff1b\u7f8e\u56fd\u5bf9IGF-1\u65e0\u7279\u5b9a\u8981\u6c42\uff0c\u8ba4\u4e3aIGF-1\u7ed3\u5408GST\u53ef\u66f4\u6709\u6548\u8bc4\u4f30GHD\u3002\u6211\u56fd\u76ee\u524d\u867d\u6ca1\u6709\u660e\u786e\u8981\u6c42IGF-1\u5fc5\u987b\u4f4e\u4e8e-2SD\u624d\u8fdb\u884cGST\uff0c\u4f46\u591a\u6570\u4e13\u5bb6\u8ba4\u4e3aIGF-1\u6c34\u5e73\u51cf\u4f4e\u518d\u505aGST\uff0c\u4ee5\u51cf\u5c11\u4e0d\u5fc5\u8981\u7684GST\u800c\u7f6e\u60a3\u513f\u4e8e\u5371\u9669\u4e4b\u4e2d\uff3b15\uff3d\u3002<\/p>\n

\u5bf9\u4e8e3\u5c81\u4ee5\u4e0b\u513f\u7ae5\u7684GHD\u8bca\u65ad\uff0c\u80f0\u5c9b\u7d20\u6837\u751f\u957f\u56e0\u5b50\u7ed3\u5408\u86cb\u767d\uff08IGFBP-3\uff09\u6c34\u5e73\u8f83\u4f4e\u88ab\u8ba4\u4e3a\u662f\u6bd4IGF-1\u66f4\u53ef\u9760\u7684\u751f\u7269\u6807\u5fd7\u7269\uff3b15\uff3d\u3002IGFBP-3\u548cIGF-1\u540c\u65f6\u68c0\u6d4b\u867d\u7136\u53ef\u4ee5\u63d0\u9ad8\u8bca\u65adGHD\u7684\u51c6\u786e\u6027\uff0c\u4f46\u4e5f\u53ef\u80fd\u53d7\u5230\u5176\u4ed6\u56e0\u7d20\u7684\u5e72\u6270\uff0c\u5bfc\u81f4\u4e8c\u8005\u5747\u964d\u4f4e\u7684\u60c5\u51b5\u51fa\u73b0\uff0c\u5982\uff1a\u957f\u671f\u8425\u517b\u4e0d\u826f\u3001GH\u4e0d\u654f\u611f\uff08\u5305\u62ecGHR\u3001STAT5B\u548cIGFALS\u7684\u9057\u4f20\u7f3a\u9677\uff09\uff3b18-19\uff3d\u3002\u4f4eIGF-1\u4f34\u6709\u6b63\u5e38\u6216\u5347\u9ad8\u7684IGFBP-3\u63d0\u793a\u53ef\u80fd\u5b58\u5728IGF-1\u7684\u9057\u4f20\u7f3a\u9677\uff3b20\uff3d\u3002\u56e0\u6b64\uff0c\u89e3\u8bfb\u5316\u9a8c\u7ed3\u679c\u9700\u8981\u7efc\u5408\u4e34\u5e8a\u4fe1\u606f\u3002<\/p>\n

\u9aa8\u9f84\u68c0\u6d4b\u5bf9\u4e8e<2\u5c81\u8005\uff0c\u8bc4\u4f30\u610f\u4e49\u4e0d\u5927\uff0c\u4e0d\u63a8\u8350\u5e38\u89c4\u68c0\u67e5\u3002\u4f46\u662f\u5bf9\u7591\u6709\u9aa8\u9abc\u53d1\u80b2\u4e0d\u826f\u7684\u60a3\u513f\u5e94\u884c\u9aa8\u9abc\u5f71\u50cf\u5b66\u68c0\u67e5\uff0c\u5982\u8eab\u6750\u6bd4\u4f8b\u5f02\u5e38\u6216\u8eab\u9ad8\u660e\u663e\u504f\u79bb\u5bb6\u65cf\u80cc\u666f\u7684\u60a3\u513f\u3002\u5934\u9885\u6216\u5782\u4f53\u6838\u5171\u632f\u6210\u50cf\u68c0\u67e5\u53ef\u914c\u60c5\u5728\u9009\u62e9\u6cbb\u7597\u524d\u5b8c\u5584\u3002<\/p>\n

3.3    \u9057\u4f20\u5b66\u68c0\u6d4b    \u67d3\u8272\u4f53\u5f02\u5e38\u3001\u9aa8\u9aba\u751f\u957f\u677f\u7684\u8f6f\u9aa8\u5185\u9aa8\u5316\u5f02\u5e38\u3001GH-IGF-1\u8f74\u5728\u5185\u7684\u5185\u5206\u6ccc\u6fc0\u7d20\u53ca\u4fe1\u53f7\u901a\u8def\u3001\u65c1\u5206\u6ccc\u56e0\u5b50\u3001\u7ec6\u80de\u5916\u57fa\u8d28\u3001\u7ec6\u80de\u5185\u4fe1\u53f7\u901a\u8def\u3001\u7ec6\u80de\u57fa\u672c\u751f\u7406\u8fc7\u7a0b\u7684\u57fa\u56e0\u7f3a\u9677\u53ca\u5370\u8ff9\u57fa\u56e0\u5f02\u5e38\u7b49\u5747\u4f1a\u5bfc\u81f4\u77ee\u5c0f\uff3b21-26\uff3d\uff0c\u5177\u4f53\u89c1\u88683\u3002\u68c0\u6d4b\u65b9\u6cd5\u5305\u62ec\uff1a\u67d3\u8272\u4f53\u6838\u578b\u5206\u6790\u3001\u4e00\u4ee3\u6d4b\u5e8f\uff08Sanger\u6d4b\u5e8f\uff09\u3001\u67d3\u8272\u4f53\u5fae\u9635\u5217\uff08chromosomal microarrays\uff0cCMA\uff09\u548c\u4e8c\u4ee3\u6d4b\u5e8f\uff08next-generation sequencing\uff0cNGS\uff09\uff0c\u5fc5\u8981\u65f6\u5916\u663e\u5b50\u7ec4\u6d4b\u5e8f\uff08exome sequencing\uff0cES\uff09\uff3b15\uff0c21-22\uff3d\u3002<\/p>\n<\/p>\n

\u9057\u4f20\u5b66\u68c0\u6d4b\u53ef\u4ee5\u6307\u5bfchGH\u6cbb\u7597\u3001\u9884\u6d4bhGH\u7684\u6cbb\u7597\u53cd\u5e94\u3001\u4f34\u968f\u75be\u75c5\u7684\u76d1\u6d4b\u3001\u9884\u540e\u5224\u65ad\u4ee5\u53ca\u65e9\u671f\u8bc6\u522bhGH\u6cbb\u7597\u7684\u7981\u5fcc\u8bc1\uff08\u5bb9\u6613\u5bfc\u81f4\u80bf\u7624\u53d1\u751f\u7684DNA\u4fee\u590d\u7f3a\u9677\u75be\u75c5\u548c\u67d3\u8272\u4f53\u65ad\u88c2\u7efc\u5408\u5f81\uff3b23\uff3d\uff09\uff0c\u4e5f\u4e3a\u9057\u4f20\u54a8\u8be2\u505a\u57fa\u7840\uff0c\u4ee5\u53ca\u5c06\u6765\u7684\u7cbe\u51c6\u6cbb\u7597\u548c\u836f\u7269\u7684\u4f7f\u7528\u63d0\u4f9b\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u4f9d\u636e\uff3b15\uff3d\u30023.3.1    \u77ee\u5c0f\u76f8\u5173\u9057\u4f20\u5b66\u68c0\u6d4b\u7684\u9002\u7528\u4eba\u7fa4    \u5728\u6cd5\u5f8b\u76d1\u62a4\u4eba\u77e5\u60c5\u540c\u610f\u4e0b\u5efa\u8bae\u5177\u6709\u4ee5\u4e0b\u4e34\u5e8a\u7279\u5f81\u7684\u77ee\u5c0f\u60a3\u513f\u8fdb\u884c\u9057\u4f20\u5b66\u68c0\u6d4b\uff0c\u4f46\u7591\u4f3cCDGP\u6216\u9884\u671f\u6210\u4eba\u8eab\u9ad8\u6b63\u5e38\u8005\u53ef\u6682\u4e0d\u8fdb\u884c\uff3b15\uff0c27-28\uff3d\uff0c\u6839\u636e\u5bb6\u957f\u7684\u9700\u6c42\u53ef\u4ee5\u8ba8\u8bba\u9057\u4f20\u68c0\u6d4b\u95ee\u9898\u3002\u4e34\u5e8a\u7279\u5f81\u5305\u62ec\uff1a\uff081\uff09\u4e25\u91cd\u77ee\u5c0f\uff08\u8eab\u9ad8<-3.0 SD\uff09\u6216\u4f4e\u4e8e\u9776\u8eab\u9ad83 SD\uff1b\uff082\uff09\u975e\u5300\u79f0\u6027\u77ee\u5c0f\u548c\uff08\u6216\uff09\u9aa8\u9abc\u53d1\u80b2\u4e0d\u826f\uff1b\uff083\uff09\u8003\u8651ISS\u60a3\u513f\u7684\u5f02\u5e38\u5206\u6790\u8303\u56f4\u5b9c\u6db5\u76d6SGA\u672a\u5b9e\u73b0\u751f\u957f\u8ffd\u8d76\u8005\u7684\u75c5\u56e0\u5206\u6790\uff1b\uff084\uff09\u53ef\u7591\u7efc\u5408\u5f81\u6027\u77ee\u5c0f\uff0c\u5982\u4f34\u6709\u7279\u6b8a\u9762\u5bb9\u3001\u7578\u5f62\u4f53\u5f81\u3001\u5c0f\u5934\u6216\u667a\u529b\u53d1\u80b2\u843d\u540e\u7b49\uff1b\uff085\uff09\u5bb6\u65cf\u6027\u77ee\u5c0f\u6216\u6bcd\u4eb2\u6709\u53cd\u590d\u4e0d\u826f\u5b55\u4ea7\u53f2\u3002\u5bf9\u4e8e\u8eab\u9ad8\u4f4e\u4e8e-2SD\uff0c\u4f46\u4e0d\u8db3-3SD\u7684\u60c5\u51b5\uff0c\u5e94\u4e0e\u5bb6\u957f\u8ba8\u8bba\u9057\u4f20\u68c0\u6d4b\u7684\u76ca\u5904\uff0c\u5c0a\u91cd\u5bb6\u5ead\u7684\u9009\u62e9\u3002<\/p>\n

3.3.2    ISS\u9057\u4f20\u5b66\u68c0\u6d4b\u8bc4\u4f30\u7684\u6d41\u7a0b    \u76ee\u524d\u56fd\u5185\u5c1a\u7f3a\u4e4fISS\u9057\u4f20\u5b66\u68c0\u6d4b\u8bc4\u4f30\u6d41\u7a0b\u7684\u5171\u8bc6\uff0c\u7ed3\u5408\u4e2d\u56fd\u9057\u4f20\u5b66\u68c0\u6d4b\u4e34\u5e8a\u5b9e\u8df5\u7ecf\u9a8c\u548c\u56fd\u5185\u5916\u7814\u7a76\uff3b4\uff0c6\uff0c27-29\uff3d\uff0c\u672c\u5171\u8bc6\u5efa\u8bae\u6309\u4ee5\u4e0b\u6d41\u7a0b\u8fdb\u884cISS\u57fa\u56e0\u68c0\u6d4b\u7684\u8bc4\u4f30\uff0c\u89c1\u56fe2\u3002<\/p>\n

\u6211\u56fd\u9057\u4f20\u5b66\u68c0\u6d4b\u76f8\u5bf9\u53ef\u53ca\u6027\u9ad8\uff0c\u6545\u672c\u5171\u8bc6\u63a8\u8350\uff1a\u8bca\u65adISS\u524d\uff0c\u5e94\u83b7\u5f97\u77e5\u60c5\u540c\u610f\u8fdb\u884c\u9057\u4f20\u68c0\u6d4b\uff0c\u4ee5\u8fdb\u4e00\u6b65\u6392\u9664\u9057\u4f20\u68c0\u6d4b\u53ef\u83b7\u5f97\u7684\u75c5\u56e0\u3002\u82e5\u65e0\u6cd5\u83b7\u5f97\u9057\u4f20\u68c0\u6d4b\u7684\u77e5\u60c5\u540c\u610f\uff0c\u53ef\u6682\u65f6\u8bca\u65adISS\uff0c\u540c\u65f6\u5bf9\u56e0\u6b64\u800c\u5ef6\u8fdf\u7684\u7cbe\u51c6\u8bca\u65ad\u548c\u7279\u5f02\u6027\u6cbb\u7597\u6216\u6cbb\u7597\u6548\u679c\u7684\u54a8\u8be2\u4e0d\u5177\u5907\u89e3\u7b54\u6761\u4ef6\u3002\u53e6\u5916\uff0c\u5373\u4f7f\u83b7\u5f97\u4e86\u9057\u4f20\u5b66\u7ed3\u679c\uff0c\u4f9d\u7136\u9700\u8981\u7d27\u5bc6\u7ed3\u5408\u4e34\u5e8a\u5b9e\u9645\u89e3\u6790\uff0c\u7279\u522b\u5f53\u68c0\u6d4b\u51fa\u7684\u53d8\u5f02\u4e3a\u7f55\u89c1\u6216\u672a\u62a5\u9053\u53d8\u5f02\u65f6\uff0c\u9700\u9057\u4f20\u5b66\u4e13\u5bb6\u5171\u540c\u8ba8\u8bba\uff3b15\uff3d\u3002<\/p>\n

4\u3000ISS\u7684\u6cbb\u7597ISS\u60a3\u513f\u6cbb\u7597\u7684\u4e3b\u8981\u76ee\u6807\u662f\u8fbe\u5230\u9057\u4f20\u9776\u8eab\u9ad8\u8303\u56f4\u6216\u513f\u7ae5\u671f\u8fbe\u5230\u6b63\u5e38\u8eab\u9ad8\u8303\u56f4\u3002\u6cbb\u7597\u5e94\u4e0e\u60a3\u513f\u548c\u5bb6\u957f\u5171\u540c\u51b3\u7b56\u5e76\u5728\u513f\u79d1\u5185\u5206\u6ccc\u79d1\u4e13\u4e1a\u533b\u751f\u7684\u76d1\u7ba1\u4e0b\u52a8\u6001\u8bc4\u4f30\u4e0d\u65ad\u8c03\u6574\u3002\u5982\u679c\u5bf9\u6cbb\u7597\u7684\u8eab\u9ad8\u589e\u957f\u53cd\u5e94\u8f83\u5dee\uff0c\u6216\u8005\u8fbe\u5230\u53ef\u63a5\u53d7\u7684\u8eab\u9ad8\u6216\u60a3\u513f\u62d2\u7edd\u6cbb\u7597\u65f6\u9700\u8981\u505c\u6b62\u6cbb\u7597\u4e13\u5bb6\u5efa\u8bae\u7ed3\u679c\u89c1\u88684\u30024.1    hGH\u6cbb\u7597    \u81ea1985\u5e7410\u6708\uff0chGH\u5728\u7f8e\u56fd\u6279\u51c6\u7528\u4e8e\u6cbb\u7597GHD\u513f\u7ae5\u540e\u5f00\u542f\u4e86hGH\u4e0a\u5e02\u540e\u7684\u56fd\u5bb6\u5408\u4f5c\u8eab\u9ad8\u589e\u957f\u7814\u7a76\uff08National Cooperative Growth Study\uff0cNCGS\uff09\uff0cISS\u60a3\u513f\u4e5f\u88ab\u5217\u4e3a\u7814\u7a76\u5bf9\u8c61\uff3b30\uff3d\u3002\u77ed\u671f\u7684\u4e34\u5e8a\u8bd5\u9a8c\u7ed3\u679c\u8bc1\u5b9e\u4e86\u4e0e\u5b89\u6170\u5242\u6cbb\u7597\u7684\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0chGH\u6cbb\u7597ISS\u7684\u6548\u679c\u826f\u597d\uff3b31\uff3d\u30022003\u5e74\uff0c\u57fa\u4e8e\u516c\u5e73\u7684\u7406\u5ff5FDA\u6279\u51c6\u4e86ISS\u4f5c\u4e3ahGH\u6cbb\u7597\u7684\u6307\u5f81\uff3b32\uff3d\uff0c\u4f46\u5f3a\u8c03\u4e86\u662f\u7b26\u5408Ht SDS<-2.25\u3001\u65e0\u6f5c\u5728\u75be\u75c5\u6216\u751f\u957f\u6fc0\u7d20\u7f3a\u4e4f\u548c\u9884\u6d4b\u6210\u4eba\u8eab\u9ad8\u8fc7\u77ee\u7684\u60a3\u513f\u3002\u4f46\u662f\uff0c\u6b27\u6d32\u836f\u54c1\u7ba1\u7406\u5c40\uff08European Medicine Agency\uff0cEMA\uff09\u51fa\u4e8e\u201c\u7f8e\u5bb9\u539f\u56e0\u201d\u8ba9\u201c\u5065\u5eb7\u77ee\u5c0f\u201d\u7684\u513f\u7ae5\u8fdb\u884c\u957f\u671f\u836f\u7269\u6cbb\u7597\u7684\u987e\u8651\u4e00\u76f4\u53cd\u5bf9hGH\u7528\u4e8eISS\u9002\u5e94\u8bc1\u7684\u4e0a\u5e02\u8bb8\u53ef\uff3b7\uff3d\u3002\u6211\u56fd\u56fd\u5bb6\u836f\u54c1\u76d1\u7763\u7ba1\u7406\u5c40\uff08Center for Drug Evaluation\uff0cCDE\uff09\u4e8e2021\u5e74\u6279\u51c6ISS\u4e3ahGH\u6cbb\u7597\u7684\u9002\u5e94\u8bc1\u3002\u672c\u5171\u8bc6\u63a8\u8350hGH\u6cbb\u7597\u7b26\u5408ISS\u8bca\u65ad\uff0cHt SDS<-2.0\u7684\u60a3\u513f\u3002\u6cbb\u7597\u51b3\u7b56\u9700\u8981\u5728\u8bc4\u4f30\u60a3\u513f\u7684\u8eab\u5fc3\u60c5\u51b5\u4ee5\u53ca\u4e0e\u5bb6\u957f\u8ba8\u8bba\u98ce\u9669\u548c\u83b7\u76ca\u540e\u6839\u636e\u5177\u4f53\u60c5\u51b5\u4f5c\u51fa\u51b3\u5b9a\u3002\u9700\u544a\u77e5\u60a3\u513f\u53ca\u5bb6\u957f\u5bf9\u8eab\u9ad8\u589e\u957f\u7684\u671f\u671b\u53ef\u80fd\u4e0e\u6cbb\u7597\u7ed3\u5c40\u548c\u7ecf\u6d4e\u82b1\u8d39\u4e0d\u7b26\uff0c\u4e5f\u9700\u8981\u544a\u77e5\u5bb6\u957fISS\u5e76\u975e\u5fc5\u987b\u6cbb\u7597\u30024.1.1    hGH\u5f00\u59cb\u6cbb\u7597\u7684\u65f6\u95f4\u548c\u5242\u91cf\u63a8\u8350    \u8d77\u59cb\u6cbb\u7597\u7684\u5e74\u9f84\u4e3a3\uff5e4\u5c81\u3002\u57fa\u4e8eISS\u60a3\u513f\u5bf9\u751f\u957f\u6fc0\u7d20\u7684\u654f\u611f\u6027\u53ef\u80fd\u53d7\u635f\uff0chGH\u7684\u63a8\u8350\u5242\u91cf\u9ad8\u4e8eGHD\u4f7f\u7528\u5242\u91cf\uff1a\u6bcf\u65e5\u6ce8\u5c04\u7684hGH\u8d77\u59cb\u5242\u91cf45 \u03bcg\/\uff08kg\u00b7d\uff09\u53730.15 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